title: Is androgen production in association with immune system activation potential evidence for existence of a functional adrenal/ovarian autoimmune system in women?
abstract: BACKGROUND
  Low functional ovarian reserve (FOR) is at all ages associated with low testosterone (T) levels. Causes are, however, unknown. We, therefore, investigate whether androgens with low FOR are associated with non-specific immune system activation.
  
  
  METHODS
  322 infertile women with low and normal FOR (controls) were assessed with a broadly based immune profile, which in previous studies has proven effective in differentiating infertile patients with and without immune system activation. Patients were either immune-positive (greater than or equal to one positive tested parameter) or immune negative (no positive test). 135 suffered from prematurely diminished FOR (POA/OPOI; < age 38), 155 from physiologic diminished FOR due to age (DOR; > age 40), and 32 were controls (< age 38 with normal age-specific FOR). Prevalence of immune-positive vs. negative was assessed in all 3 patient groups.
  
  
  RESULTS
  Women with immune abnormalities, overall, demonstrated higher total T (TT, P = 0.004) and free T (FT, P < 0.001) levels than those without. The three clinical and two immunologic-defined patient groups demonstrated significant statistical interaction in mean TT (P = 0.008), with mean TT and FT in women with positive immune findings being significantly higher in control than in POA/OPOI and physiologic DOR patients (all 4 differences P < 0.001). No such differences between the three groups were seen in women without immune abnormalities.
  
  
  CONCLUSIONS
  In this study we used a definition of immune-positivity, which favors sensitivity over specificity, resulting in significant numbers of false-positives but likely only few false-negatives. The study allows suggesting the possibility of an immune system-derived androgen-production factor (APF), which maintains normal androgen levels but is deficient in women with low FOR and immune system inactivity. Existence of such an APF would suggest the presence of a still unknown functional adrenal autoimmune system.
authors.affiliation: Center for Human Reproduction, New York, NY 10021, USA. ykizawa@thechr.com
authors.forename: Norbert
authors.initials: N
authors.lastname: Gleicher
authors.forename: Andrea
authors.initials: A
authors.lastname: Weghofer
authors.forename: Vitaly A
authors.initials: VA
authors.lastname: Kushnir
authors.forename: Aya
authors.initials: A
authors.lastname: Shohat-Tal
authors.forename: Emanuela
authors.initials: E
authors.lastname: Lazzaroni
authors.forename: Ho-Joon
authors.initials: HJ
authors.lastname: Lee
authors.forename: David H
authors.initials: DH
authors.lastname: Barad
mesh_terms: D000311:Adrenal Glands / Q000276:immunology*; D000328:Adult; D000704:Analysis of Variance; D000728:Androgens / Q000097:blood; D001323:Autoantibodies / Q000097:blood; D015551:Autoimmunity / Q000276:immunology*; D015992:Body Mass Index; D005260:Female; D006801:Humans; D007107:Immune System / Q000276:immunology*; D007247:Infertility, Female / Q000097:blood / Q000276:immunology; D008875:Middle Aged; D010053:Ovary / Q000276:immunology*; D013739:Testosterone / Q000097:blood*
chemical_list: D000728:Androgens; D001323:Autoantibodies; D013739:Testosterone